Vaccine as Metaphor

On Immunity is a brilliant book-length essay about very old fears.

Let’s begin by stating the obvious: Becoming a parent changes the way you see the world. I don’t mean this in any kind of spiritual or far-reaching or even especially personal way. What I mean is that things—objects, surfaces, let’s not even mention people—begin to take on a different aspect once your son or daughter is tottering around among them. The whole setup begins to seem charged with risk, with a kind of malicious indifference to the small and incalculably precious body now taking its place within it. The world itself becomes a hysterically lavish smorgasbord of choking hazards, an embarrassment of options for strangulation and electrocution, for falling off of things, out of things, into things. That pen cap you left lying on your desk? Ideally proportioned for the 18-month-old windpipe. Your parents’ back garden? A very gauntlet of dog turds and fox urine and other unseen perils, in which any single blade of grass might host sufficient bacteria to level a good-sized nursery. The child himself becomes a mobile point of concentrated vulnerability, moving haphazardly and adorably about a landscape of treacherous potential. It’s a kind of controlled madness, this way of viewing the world—a form of necessary neurosis, which is also more or less totally sane.

In her elegant and bracing new book On Immunity: An Inoculation, Eula Biss explores a particular area of this rich psychological terrain. The book is a long essay on the theme of vaccination, on the fears and delusions and associations that swirl around the central idea of immunizing a child from sickness, from the world itself. Although Biss’s explorations are wide and various—taking in literature, mythology, political theory, history, science—her own maternal anxieties are always a vivid presence in the writing. In a powerful image in the book’s opening pages, she reveals herself in the liminal space between one phase of a life and the next. She is in the early stages of labor, walking to the end of a Lake Michigan pier with her husband, who begins to film her with his video camera, and asks her to deliver some message to the future. Due to a technical glitch or oversight, the sound fails to record, and so, watching it now some years later, all that is communicated to her is her own apparent fearlessness. “During the long labor that followed that sunlit moment,” she writes, “I imagined myself swimming in the lake, which became, against my will, a lake of darkness and then a lake of fire and then a lake without a horizon. By the time my son was born the next day a cold rain was falling and I had crossed over into a new realm in which I was no longer fearless.” On Immunity is, among many other things, an attempt to map this new realm.

Biss’s son was born during a period of widespread contagion and fear, with the H1N1 pandemic dominating the headlines, a moment in which she saw her own anxieties reflected and magnified in the panic gripping the world outside. “It all became part of the landscape of new motherhood,” she writes, “where ordinary objects like pillows and blankets have the power to kill a newborn. Colleges were daily sterilizing every ‘high-touch’ surface, while I was nightly boiling every object my child put in his mouth. It was as if the nation had joined me in the paranoia of infant care.” This interaction between the private and public is Biss’s central theme and her primary method: Her writing keeps passing back and forth between the interior and exterior, between the personal and the political, between the self and the other—always complicating, as it does so, these frequently fanciful distinctions.

Because to think about infection and disease is also to think about the ways in which our bodies are never as neatly defined against the world as we want them to be. A virus doesn’t have much respect, certainly, for philosophical and legal notions of the individual as a bounded entity, or for ideas of bodily integrity. We fear contagion because we know that we, and the people we love, are on a fundamental level organisms among other organisms within an undifferentiated vastness of cells and microbes. (Biss points out that our own adaptive immune system is believed to have “borrowed its essential technology from the DNA of a virus,” quoting the science writer Carl Zimmer’s observation that, when it comes to humans and viruses, “there is no us and them.”)

And so the practice of vaccination can seem like a kind of devil’s bargain with this notionally external world of illness and disease. There is something neatly mythological about the idea of contaminating a child with the very danger you hope to save him from. Achilles, Biss reminds us, was dipped in the River Styx as an infant by his mother in an effort to inoculate him against mortality. Slowly and skillfully, Biss teases out these associations, revealing the folk-medicinal roots of the practice of vaccination. In 18th-century England, she writes, milkmaids had faces unmarked by the ravages of smallpox—a disease that nearly everyone else wound up with at that point in English history, and that left the faces of its survivors pocked and scarred. Folk knowledge held that milkmaids who milked cows with cowpox, and developed blisters on their hands, were immune to contracting smallpox even while nursing victims of an epidemic. In 1774, a lunatic visionary farmer used a darning needle to inject pus from an infected cow into the arms of his wife and two young sons, much to the horror of his neighbors. The wife fell ill but eventually recovered, while the sons had only mild reactions; all were exposed to smallpox on numerous occasions, sometimes specifically in order to demonstrate their resistance, without ever contracting the disease. (It is from the Latin word for cow, vacca, that we get the term vaccination.)

Like many of the most interesting contemporary essayists—Rebecca Solnit comes to mind here as a useful comparison—Biss approaches the form with the sensibility of a poet. This isn’t so much a matter of her prose having a poetic density or charge, as of the composure with which it moves between subjects, bringing disparate parts into a stylized whole. She’s concerned with fear and inoculation and sickness, but considers them in such a way that everything is always a potential metaphor for something else—and this generates a kind of poetic alertness in the reader, an awareness that the topic at hand might at any point suddenly reveal itself, under the insistent pressure of the author’s gaze, as some other thing entirely. I found this passage, for instance, particularly beautiful, and even moving, for the way that its description of a child’s immune system becomes an oblique description of childhood itself, and the work of parenting:

There are certain things that the infant immune system does not do well—it has trouble penetrating the sticky coating of the Hib bacteria, for example. But the immune system of a full-term infant is not incomplete or undeveloped. It is what immunologists call “naive.” […] A vaccine tutors the infant immune system, making it capable of remembering pathogens it has not yet seen. With or without vaccination, the first years of a child’s life are a time of rapid education on immunity—all the runny noses and fevers of those years are the symptoms of a system learning the microbial lexicon.

For a book of its length—fewer than 200 pages, comprised of several dozen short sections—On Immunity is remarkable for its scope. Biss’s reading of the political dimensions of vaccination, on the ways in which one’s own health and sickness are contingent on that of others, is particularly thoughtful and penetrating. Vaccinating is not just something we do for ourselves, she insists, but something that we do for society—for each other. The health of those whose immune systems are weak or compromised, Biss writes, is often contingent on the inoculation of people who might otherwise carry a disease without being themselves affected by it. And vaccination and its refusal have always existed within a political and ethical context: “Vaccines govern the immune system,” she writes, “in the sense that they impose a particular order on it. British anti-vaccinators in the 19th century compared their movement to the Irish Home Rule movement, conflating the governance of a country with the governance of a body. We resist vaccination in part because we want to rule ourselves.”

Eula Biss.

Courtesy of Graywolf Press

Biss handles with real intellectual seriousness and sensitivity the fears of those who oppose the vaccination of infants. It’s a subject that is often presented, in an unsubtly gendered way, as a conflict between a bunch of hysterical young mothers and a soberly paternal scientific consensus. She acknowledges that these fears are misaligned, but refuses to dismiss them, and writes out of an understanding of where they might be coming from—a fear of toxicity, of the impure and the unnatural, and an intuitive unease with the devil’s bargain of inoculation that is heightened by a contemporary context of a world drowning in pollutants, both chemical and moral. “That so many of us find it entirely plausible that a vast network of researchers and health officials and doctors worldwide would willfully harm children for money is evidence of what capitalism is really taking from us.” (Something like this logic might usefully be applied to the more elaborate misinterpretations advanced by conspiracy theorists, with their Illuminati bloodlines and their arcane cryptographies. Whenever I hear someone talking about the New World Order or some other hidden elite running the whole show at the expense of the rest of us, I want to gently suggest that they might just be overthinking it, and that they should maybe try looking into this whole capitalism thing.)

Biss has interesting things to say about the relationship between the medical profession and its subjects, and she says them in an interesting way. Her discussion of medical paternalism is complex and nuanced. “Paternalism has fallen out of favor in medicine,” as she puts it, “just as the approach to fathering that depends on absolute authority no longer dominates parenting. But how we should care for other people remains a question.” What has largely replaced the doctor-as-father model, she argues, is the doctor-as-waiter model, whereby the authority of the consumer who knows what he wants has superseded that of the physician who knows what he needs. Her not-entirely-negative view of medical paternalism clearly has a lot to do with a wonderfully literal example of it: her own oncologist father, who plays a small but crucial recurring role in the book, as alternately an assuager and legitimizer of her various anxieties about her son’s health. And so the discussion of medical paternalism is worked out, on one level, through her discussions with her father, which are revealed as part of some larger cultural exchanges: with the question of what it means to be a physician and a patient, to be a parent and a child. Of what it means, in other words, to care and be cared for.

The power of Biss’s book stems, in the end, from its subtle insistence on the interrelationship of things—of the mythological and the medical, the private and the public, the natural and the unnatural—and on the idea that one’s relationship with disease and immunity is not distinct from one’s relationship with the world. “We are in other words,” as she puts it, “continuous with everything on earth. Including, and especially, each other.”